What Makes Us unique

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Care in the Countryside

Mellor Nook is one of a very few care homes to be located in the green
belt. We take every opportunity to embrace and celabrate our rural situation

Family Run Bussiness

It is very unusual nowadays for a care home to be run by the same family
for over 30 years. More inportantly in our opinion is that we live here
on the premises. This is our home too

What people say

CQC inspector

" Mellor Nook is unique"

Doctors

"what a fantastic place to spend your retirment"

Relatives

"the staff are willing to go the extra mile"

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Comment on our Blog

Delivering the Care

Moving into care is often accompanied by negative feelings and a sense
of loss of status.This is understood and taken into account by the staff
here at Mellor Nook, to minimize as far as possible the loss of self-confidence
and the failing sense of self-worth. Receiving intimate care in a new
setting, often away from loved ones, especially at a time of adjusting
to the 'home' as home, may be particularly difficult. Some people may
resent their increased dependency, the need to receive care in a new and
different environment and their reliance on staff. Their sense of loss
may be similar to a feeling of bereavement. Staff are sensitive to these
feelings and assist in helping enable residents to come to terms with
their changing needs. For people with impaired memory and reasoning, the
transition may be bewildering.

Living in a home in no way diminishes residents' rights of access to
health and rehabilitative services available in the community. This includes
the right to choose his or her own GP and to see him or her in private.
Managers & Deputies seek the consent of the resident, to be kept informed
of any necessary changes in the resident's care. In the case of Mellor
Nook, the rights of residents to have access to community nursing services
are not diminished in any way. Mellor Nook has a right of access to available
community resources and advice in the interests of their residents.

The care provided at Mellor Nook is tailored to meet the needs (social,
personal, or medical) of each individual. It is provided on the
basis of an assessment that is both timely and comprehensive. At all times
care is provided with respect and in a manner that is sensitive, maintaining
the dignity of whoever is receiving care. The privacy of individuals,
particularly in all matters dealing with intimate care-giving, is ensured
at all times and their cultural and gender needs and sensitivities are
always be recognized.

Care is given by, or supervised by, skilled and trained people; training
opportunities are provided for staff at all levels and are encouraged
to take them up. The importance of early recognition of symptoms particularly
mental health problems (for example, depression and dementia) cannot be
overemphasized. The first essential is to ensure that the causes of any
symptoms are diagnosed and any necessary treatment given. Many kinds of
physical illness can give rise to an acute confused state, as can over-sedation
or other inappropriate medication. Dementia is the condition that generally
gives cause for most concern but depressive illness is very common in
old age and can be mistaken for dementia. Delusional symptoms can develop
in an otherwise intact personality. All these conditions can be cured
or at least alleviated and the managers and senior staff at Mellor Nook
take responsibility for seeing that no such illness is ignored. Junior
staff are trained to recognise symptoms as they appear. The GP is always
contacted at the first signs of any problems.

Care giving is never coercive, and we always guard against risk of abuse
and restraint. Nothing is done which makes individuals lose their self-esteem.
Even at their most frail and vulnerable, individuals are helped to make
choices about the care they receive.

The continuum of care

In April 2002 the National Care Standards Commission replaced the Registered
Homes Act 1984 which made a distinction between residential care homes
(in Part I) and nursing homes (in Part II). Under the Act, residential
care homes provided accommodation and personal care while nursing homes
provided care which required the skills of, or supervision by, a registered
nurse. This in essence is still the case however now the distinction is
solely in registration classification. In practice the differences are
sometimes hard to define, particularly because of the changing needs that
an individual may experience while remaining in the same setting. Some
flexibility is given when taking into account fluctuations in residents'
health. C.QC. will review the position periodically to determine whether
changes in registration are required. Under this new Umbrella of “Care
Home”, Mellor Nook ensures that any nursing care provided is under the
control of a community nurse with an agreed protocol relating to named
individuals within the home.

Types of care

Care at Mellor Nook is provided holistically that is, looking at the
whole needs of residents as individuals and not isolating different elements
of care into separate unrelated tasks. However, for the purposes of this
guide it is useful to identify different elements to help clarify roles
and responsibilities

Social support

Social support within Mellor Nook is the support which is provided to
older people to enable them to function as social beings. It includes
social activities designed to enhance residents' sense of well-being,
moral support, care and attention paid to ensure individuals can maintain
contact with family and friends in the community, and making advice and
advocacy available to help individuals deal with their personal, financial
and legal affairs if desired. Attention to the spiritual needs of individuals
is also important and care is taken to identify what those needs may be
for particular individuals.

The provision of social support is an integral part of many of the daily
activities at Mellor Nook. It forms an element in getting up, eating and
drinking, being involved in social activities within the home, having
spiritual needs attended to, getting around the building and garden, and
going to bed. Other sections in this guide deal with these aspects in
more detail. Staff are alert to the needs of residents and spend time
listening to their views on what sort of activities they may wish to become
involved in or stay away from.

Personal care

Personal care is the intimate tending of physical needs, which the individual
finds difficult or impossible to do alone. Some sorts of personal care
is given during the normal pattern of daily life helping a resident to
get around, helping at mealtimes. Other aspects require privacy and sensitivity
washing and bathing, going to the toilet. The individual are always able
to choose where and when these activities are performed and are not subject
to rigid routines. All equipment used is personal to the individual (flannels,
soap, etc).

Nursing care

Many of the functions categorised as nursing care are carried out under
the supervision of a community nurse or the resident's GP (as would be
the case if the resident were still living in his or her own home).

The holistic approach that Mellor Nook uses looks to the needs of the
whole individual. Following assessment of care needs, staff may work closely
with individual residents, or seek advice on care delivered by others.
Nursing involvement in the form of consultation with both community nurse
and GP is essential for the overall assessment, monitoring and coordination
of health care.

The care component at Mellor Nook is structured to include all following
and is undertaken by the Manager, or by a care worker under the supervision,
where appropriate, of a community nurse:

On occasions nurses who have specialist expertise and experience will
be required to attend residents who, for example, have cancer, diabetes,
a psychiatric illness, challenging behaviour or who are dying. Agreements
and protocols with local trusts ensure the availability of nurses in these
situations.

Medical care

Medical care may be required on a regular or intermittent basis, either
from a GP or specialist consultant after referral by a GP, depending on
specific medical needs. Our close links with GPs are invaluable. Residents
retain their own GPs if they wish, and they are willing, without feeling
pressure to register with a local one who acts as the home's overall GP.
However, in some cases, where the person's GP does not want to continue
looking after the patient after entry into a home, this may be the only
option. GPs involved in providing medical care and advice to residents
in Mellor Nook have experience and proven interest in the care of older
people.

Relationships with outside health services

Protocols have been established with GPs and local hospital consultants
for dealing with discharges from and admissions to hospital, clarifying
the roles and responsibilities of all parties and for visiting residents
at Mellor Nook. Staff from the local psychogeriatric service such as the
consultant psychiatrist, the psychologist and the community psychiatric
nurse (CPN) are very helpful in planning and reviewing the care and treatment
of people with who may be developing dementia and depression. Health promotion
advisors from the local health authority are involved in developing activity
programmes for residents.

Community nursing and specialist nursing
care

Mellor Nook does not have qualified nursing staff so protocols have been
agreed setting out arrangements for local community nursing services to
be available for residents when they need nursing care. Clear lines of
communication have been established which are known to all staff about
when and how to call in community nursing services. Similar arrangements
have been established with specialist nursing services (Incontinence,
CPNs, or specialist nurses from the community nursing service for diabetes,
for example) are also available to Mellor Nook.

Administration of medication

Staff at Mellor Nook take meticulous care over the administration of
drugs. Only nominated and trained staff are involved in giving medication
to residents. Procedures are in place to ensure the wrong drug is never
administered. Some conditions, for example diabetes or Parkinson's Disease,
require a strict drug routine which may not fit into the daily meal pattern.
These routines are observed with care.

Medicines are kept safely and locked away, with full records of their
receipt, administration and disposal. Medicines are administered directly
to the resident and a record is taken they are not transferred to open
unnamed containers for distribution. If the medicine is not taken it is
disposed of and accounted for in line with the C.Q.C. disposal of drugs
policy.

The dangers of polypharmacy

A common problem amongst residents is the large number of drugs (polypharmacy)
which they are taking, often over a period of years without any proper
review. Sometimes this leads to unwanted effects or unnecessary confusion.
The use of sedatives and sleeping pills is sometimes prescribed as a matter
of course. Drugs’ being prescribed from hospital without any proper feedback
to the resident’s GP and vice versa may cause a problem. We try to eliminate
this by the GP reviewing the medication on admission to the home and review
it regularly thereafter every two or three months.

Non-prescribed remedies

Non-prescribed remedies are purchased separatelyfrom the Co-op Pharmacy
in marple and they do not sell us any item that may react with prescribed
medication

Care plans

Mellor Nook uses acloud based syatem called the PassSystem for our Care Planning

Care plans for individual residents at Mellor Nook are to ensure that
each resident receives the individual care he or she requires. They are
a necessary part of the record-keeping of the home and facilitate good
communication between residents and internal and external staff. Residents
(and their relatives where appropriate) are encouraged to take a lead
in saying how they would like to be looked after. Care plans are the basis
for daily care and they are referred to regularly and updated as appropriate.
They are available to relevant staff at all times. Consistency in their
implementation is one of our most important concerns. Residents have direct
access to them, at any time. Their permission is sought before people
other than the responsible care staff can see them and use the information
they contain. With the individual resident's permission, the care plan
is used by inspectors as one means of checking on the quality of care
provided at Mellor Nook.

Drawing up care plans

Care plans at Mellor Nook have been developed specifically for our residents
and environment. The following areas are what have been taken into consideration.

· assessments covering the major areas of care. If assessments have been
made before coming into care, they form the starting point;

· specific assessments if not already completed are undertaken and included
in the plan.

· deciding with the resident the best way to provide the care. This includes
any contributions that relatives are able to make;

· the plan is monitored and reviewed at prescribed intervals, usually
every three to six months. The review focus’s on the resident's experience
and opinion on what should happen in the future;

· the care is revised in the light of care plan reviews;

· the plan is confidential and remains the property of the resident.
We endeavour to make the Mellor Nook Care plans factual and jargon-free.

· general health record (including past medical history which affects
present functioning);

· risk assessments for safety;

· the extent of confusion or challenging behaviour;

· risk assessments for manual handling;

· medications and treatment (and whether the resident is able to look
after this personally);

· any nursing care required by the community nurse;

· ability of resident to care for self;

· any help required and preferences as to how this should be given;

· any preferences about future care options;

· religious, spiritual and cultural background;

· expressed wishes in relation to death and dying.

Wherever possible, clear and attainable goals are set out in the care
plan which the resident and care staff can follow on a planned basis,
with a time-scale (which is not too far in the future) for achievement.
In this way progress is monitored and incentives given to both resident
and staff.

Key workers

It is Mellor Nook’s policy not to run a key worker system the reason
for this is mainly the size of the home and the staffing constraints.
All staff are able to have constant interaction with all residents at
all times.